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Abbo L, Shukla BS, Giles A, Aragon L, Jimenez A, Camargo JF, Simkins J, Sposato K, Tran TT, Diaz L, Reyes J, Rios R, Carvajal LP, Cardozo J, Ruiz M, Rosello G, Cardona AP, Martinez O, Guerra G, Beduschi T, Vianna R, Arias CA. Linezolid- and Vancomycin-resistant Enterococcus faecium in Solid Organ Transplant Recipients: Infection Control and Antimicrobial Stewardship Using Whole Genome Sequencing. Clin Infect Dis 2020; 69:259-265. [PMID: 30339217 DOI: 10.1093/cid/ciy903] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vancomycin-resistant enterococci are an important cause of healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Linezolid is the only drug currently approved by the US Food and Drug Administration to treat vancomycin-resistant enterococci; however, resistance to this antibiotic appears to be increasing. Although outbreaks of linezolid- and vancomycin-resistant Enterococcus faecium (LR-VRE) in solid organ transplant recipients remain uncommon, they represent a major challenge for infection control and hospital epidemiology. METHODS We describe a cluster of 4 LR-VRE infections among a group of liver and multivisceral transplant recipients in a single intensive care unit. Failure of treatment with linezolid in 2 cases led to a review of standard clinical laboratory methods for susceptibility determination. Testing by alternative methods including whole genome sequencing (WGS) and a comprehensive outbreak investigation including sampling of staff members and surfaces was performed. RESULTS Review of laboratory testing methods revealed a limitation in the VITEK 2 system with regard to reporting resistance to linezolid. Linezolid resistance in all cases was confirmed by E-test method. The use of WGS identified a resistant subpopulation with the G2376C mutation in the 23S ribosomal RNA. Sampling of staff members' dominant hands as well as sampling of surfaces in the unit identified no contaminated sources for transmission. CONCLUSIONS This cluster of LR-VRE in transplant recipients highlights the possible shortcomings of standard microbiology laboratory methods and underscores the importance of WGS to identify resistance mechanisms that can inform patient care, as well as infection control and antibiotic stewardship measures.
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Affiliation(s)
- Lilian Abbo
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida.,Department of Pharmacy Practice, School of Pharmacy, Presbyterian College, Clinton, South Carolina
| | - Bhavarth S Shukla
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Amber Giles
- Department of Pharmacy Practice, School of Pharmacy, Presbyterian College, Clinton, South Carolina
| | - Laura Aragon
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Adriana Jimenez
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Jose F Camargo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Jacques Simkins
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Kathleen Sposato
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Truc T Tran
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia
| | - Lorena Diaz
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia.,Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Jinnethe Reyes
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia.,Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Rafael Rios
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Lina P Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Javier Cardozo
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Maribel Ruiz
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Gemma Rosello
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Armando Perez Cardona
- Department of Pathology and Laboratory Medicine, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Octavio Martinez
- Department of Pathology and Laboratory Medicine, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Giselle Guerra
- Division of Nephrology, Department of Medicine, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Thiago Beduschi
- Division of Liver and Gastrointestinal Transplant Surgery, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Rodrigo Vianna
- Division of Liver and Gastrointestinal Transplant Surgery, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia.,Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Center for Infectious Diseases, University of Texas Health Science Center School of Public Health, Houston, Texas
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Chabros L, Szymanek-Majchrzak K, Mlynarczyk A, Sawicka-Grzelak A, Durlik M, Paczek L, Chmura A, Mlynarczyk G. Evaluation of the prevalence of insertion element IS16 in vancomycin-resistant enterococci strains of Enterococcus faecium isolated from transplantology patients from a Warsaw Hospital between 2010 and 2012. Transplant Proc 2014; 46:2583-5. [PMID: 25380871 DOI: 10.1016/j.transproceed.2014.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study included 79 vancomycin-resistant Enterococcus faecium (VRE) strains isolated from 33 patients after kidney (n = 19) or liver (n = 14) transplantation; these patients were hospitalized between 2010 and 2012. The strains were obtained from infected persons as well as from carriers. All examined strains were tested for the susceptibility to antimicrobials active against enterococci and for the presence of vanA and vanB genes as well as the presence of the insertion sequence IS16 considered as one of the markers of hospital-associated strains. All 79 VRE strains of E faecium possessed IS16 and the vanA (vanB-negative) determinant. All tested strains were resistant to at least three groups of drugs; therefore, they were recognized as multidrug resistant. All isolates were resistant to glycopeptides, ampicillin, and most were resistant to tetracyclines, macrolides, nitrofurans, and high concentrations of aminoglycosides. The presence of insertion element IS16 and multiple resistance determinants prove that strains colonizing or infecting solid organ recipients were typical nosocomial pathogens.
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Affiliation(s)
- L Chabros
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland
| | - K Szymanek-Majchrzak
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland
| | - A Mlynarczyk
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland; Department of Dental Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Sawicka-Grzelak
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland; Department of Transplant Medicine and Nephrology, Transplantology Institute, Medical University of Warsaw, Warsaw, Poland
| | - L Paczek
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland; Department of Immunology, Transplantology and Internal Diseases, Transplantology Institute, Medical University of Warsaw, Warsaw, Poland
| | - A Chmura
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland; Department of General and Transplantation Surgery, Transplantology Institute, Medical University of Warsaw, Warsaw, Poland
| | - G Mlynarczyk
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital (IJTH) in Warsaw, Warsaw, Poland.
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Mlynarczyk A, Szymanek-Majchrzak K, Kosykowska E, Grzybowska W, Tyski S, Mrowka A, Baczkowska T, Durlik M, Pacholczyk M, Chmura A, Ciszek M, Paczek L, Mlynarczyk G. The dominant sequence types of vancomycin-resistant Enterococcus faecium among transplantation ward patients. Transplant Proc 2012; 43:3132-4. [PMID: 21996246 DOI: 10.1016/j.transproceed.2011.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Vancomycin-resistant enterococci (VRE) frequently cause therapeutic problems and provide information about the epidemiological condition of the ward. MATERIALS AND METHODS VRE isolated from patients on transplantation wards in 2007-2008 were compared using 2 molecular methods: RFLP-PFGE (restriction fragment length polymorphism-pulse field gel electrophoresis) and MLST (multilocus sequence typing). RESULTS The analysis covered 29 Enterococcus faecium strains resistant to glycopeptides, each from a different patient. All organisms were typed using 2 molecular methods. MLST results were compared with an international base. The 30 examined strains belonged to 8 different worldwide known sequence types. All could be recognized as representatives of a single clonal complex CC17. CONCLUSION Both methods of typing appeared to be useful to asses the epidemiological condition of the investigated wards.
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Affiliation(s)
- A Mlynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Poland
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